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Date�Z���C <br />AppNcation For <br />PUBLIC VOIORKS PERIVIIT <br />Print or Type Only <br />� � ,�jiY.S 23/ L /����5 iD� :_i,/� <br />Applicent <br />Describe Proposed Work <br />ProlPct Address (if known) <br />MaiVing Address <br />� <br />Mailing Address <br />�M,' J,�,: <br />,,� _ �,, <br />Pu0licWorke.b�mit• /��p_�� <br />eiee. o�n�.. �,6/!��/ — <br />Puef¢ wo�ka Fee -- <br />TalalFeo S <br />Less AOp� Fev PaIE $ _ <br />e,�o��ao�a S 2��'a <br />r✓'va� <br />= G �C <br />:s�_ 9�0� <br />ZiP Phone <br />Attar,h four (4) copies of plans foi p��posed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />O Outlind and dimens�ons of all existing and <br />proposed slruG..�res on the lot <br />• Exis�in� and proposod utilities <br />PERMIT CONDITI(iNS <br />Z <br />• Centerline ol slreel <br />• Indicate North <br />• Show any prop�:,ed grading changes <br />• Shav measuremenis <br />1. .111 calls Ic• i�,spection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All work sn311 be perlormed in accordance with ihis peimi� and current City ol Everett Design and Construction <br />StandarAs and Specifications. <br />3. Gall Location Underground Service 48 hrs. belore you di9. TOLL FREE NUMBER 7-800•424•5555. <br />4, ANY GRADING DONE ON THIS LOT <br />SURROUNDING LOTS WITH RAINWATFR <br />5, UOWNSPOUTS FROM THE BUILDING <br />DRAINAGE SYSTEt9. <br />6. ANY CURB & GUTTER OR SIDEWALK <br />NEPLACED 6Y THE APPLICANT. <br />SHALL BE DONE SO AS NOT TO IMPACT THE <br />RUNOFF. <br />ARE TO BE TIGHT-LINED TO THE PUBLIC <br />DAt4AGED DURING CONSTRUCTION SHALL BE <br />7��z _� �rv��-S� ,� 7 —86 <br />A��rovedfor nstr 'on Date <br />� -�-�- <br />FINAL INSP TION \_ Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Stieet <br />Everett, 4VA 98201 <br />Phone: 259-8815 <br />ACKPICWLEOGEMENT OF CONDITIONS <br />W <br />� <br />� <br />�� <br />� <br />� <br />O <br />The undersignetl owner/applicant hereby agrees to holo and save harm- <br />less the City of Everett Irom any and all claims lor damages, cosis. <br />ezpenses, or causes of aclion that may arise because oi installation <br />and maintenance of the improvement or other right�o4way use hereto <br />applied tor and further agrees !n remove same upon notice irom ihe <br />Ciry and to replace public property damaged thereby. <br />�--�_ 3�0�� <br />Sic�nalure ol Applican � Date <br />WORK AUThIORIZED BY THIS PERMI'( MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURAfION. <br />